Coding Cues: Coding for immunizations

Key Points

Our family practice has been using immunization codes 90465-90468 for patients who are 8 or younger and 90471-90474 for older patients, but we were recently told that this is incorrect. Can you tell us what's wrong and how to fix it?

There's been a lot of confusion about those codes. To clarify: The primary difference between the 9046_ and 9047_ range of codes (besides the indicated age reference) is that the 9046_ codes have a component of physician counseling associated with them. The way the codes are described makes it appear that only the 9046_ codes may be used for patients 8 years old and younger. That's not the case, but it is anticipated that counseling is more likely when immunizations are given to patients in that age range.

If immunizations are administered without counseling, the 9047_ codes should be used, regardless of age. When you do use the 9046_ codes, documentation must support it. I suggest documenting the topics discussed-a review of studies that have failed to link the increase in autism and immunizations, for example-and the amount of time devoted to counseling.

The author, vice president of operations for Reed Medical Systems in Monroe, MI, has more than 30 years' experience as a practice management consultant, as well as being a certified coding specialist, certified compliance officer, and a certified medical assistant.